Provider Demographics
NPI:1619353513
Name:SOC HEALTH SOLUTIONS CDS LLC
Entity Type:Organization
Organization Name:SOC HEALTH SOLUTIONS CDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-402-3347
Mailing Address - Street 1:5261 DELMAR BLVD STE 309B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1013
Mailing Address - Country:US
Mailing Address - Phone:470-234-4198
Mailing Address - Fax:
Practice Address - Street 1:5261 DELMAR BLVD STE 309B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1013
Practice Address - Country:US
Practice Address - Phone:470-234-4198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care